Objective To explore the value of 18 F-FDG PET/CT in preoperative evaluation by analyzing the clinical characteristics and PET/CT metabolic parameters of liver transplantation patients with liver cancer. Methods A retrospective study from October 2014 to May 2017 was carried out, a total number of 92 patientswith liver cancer who received liver transplantation and had PET/CT examination pre and post operation in Tianjin First Central Hospital were enrolled. Metabolic parameters were measured or calculated using TrueD software including the maximum standardized uptake value（SUVmax）of normal liver parenchyma，liver cancer lesions and mediastinum，SUV normalized to lean body mass（SUL），tumor metabolic volume（MTV），tumor-to-mediastinum SUV ratio（TMR），tumor-tonormal liver SUV ratio（TLR）and total lesion glycolysis（TLG）. The correlation between metabolic parameters and clinical characteristics and their value in predicting pathological indicators were analyzed by one-way analysis of variance（ANOVA）， and the correlation between metabolic parameters was analyzed to calculate the Pearson correlation coefficient. Results A total number of 90 patients had a history of hepatitis，including 83 cases of hepatitis B，5 cases of hepatitis C， 1 case of hepatitis B and D，and 1 case of autoimmune hepatitis. The high，medium and low pathological differentiation cases were 28，36 and 22，respectively. Two cases with unclear differentiation and 4 cases had no tumor. There were 90 cases of negative stump or incisal edge of vena cava，portal vein and biliary system，and 2 cases were positive. A total number of 64 cases were negative for satellite nodules and 28 cases were positive. 51 cases were negative of microvascular invasion（MVI）and 41 cases were positive. A total number of 60 patients were negative of detected portal vein and interstitial vascular tumor embolus and 32 cases were positive. The correlation coefficient between the SUVmax of liver background and mediastinum background（LBmax，Mmax）was 0.867，and LBmax was higher than Mmax. The correlation coefficient between SUVmax and SUL was 0.985 and the correlation coefficient between TLR and TMR was 0.986. There was no difference between the metabolic parameters of different TNM stages. There was no significant difference between the metabolic parameters of hepatocellular carcinoma group and cholangiocarcinoma group，no difference was observed in moderately and poorly differentiated groups. There was no difference in the metabolic parameters when considering the tumor number，tumor site，cirrhosis，hepatitis type and activity，cancer thrombus，AFP level，negativity of stump or incisal edge of vena cava，portal vein and biliary，negativity of detected portal vein and interstitial vascular tumor embolus. There were significant differences in SUVmax，TMR，TLR，SUL，MTV and TLG between lymph node metastasis group and non-metastasis group（P ＜ 0.05）. There were significant differences in SUVmax，TMR，TLR and SUL and no significant differences in MTV and TLG between satellite nodules negative and positive groups（P ＜ 0.05）. There were significant differences in TMR，TLR，SUL and TLG between MVI negative and positive groups（P ＜ 0.05），and there was no significant difference in SUVmax and MTV between the two groups. Conclusion 18 F-FDG PET/CT can evaluate the tumor distribution and stage accurately and comprehensively，identify the degree of tumor differentiation，predict MVI，and so as to predict the prognosis of liver transplantation patients

Objective To investigate the effect of microwave ablation on pulmonary oligometastasis of liver transplant recipients without hepatic carcinoma. To observe the imaging changes after ablation. Methods A total number of 14 patients with 15 lesions were analyzed retrospectively. The ablation effect，complication and progression-free survival（PFS）were calculated. A total number of 15 lesions were divided into two groups，one group used the energy of 40 watt for 5 minutes，another group used the energy of 60 watt for 3 minutes . The short diameter and long diameter of ablation area were compared. The patient received follow up regularly. Results All the lesions were ablated by one procedure. The ablation area displayed“target sign”on CT image at first，then the lesion decreased in size during follow up，only fibrous scar can be observed at last. Different energy of 60 watt for 3 minutes and 40 watt for 5 minutes can get the same ablation effect. After ablation，the size of the short diameter and long diameter increased significant. The complication of pneumothorax was high（up to 71.4%）and 60% needed drainage. Incidence of bleeding of puncture tunnel and pain were 21.4%、28.6% respectively. Progression-free survival（PFS）was 7.4 months. Conclusion Microwave ablation can control pulmonary metastasis with acceptable complication. The ablation area displaied“target sign”on CT image.

Objective To study the differences and relationship of hepatic and renal excretion patterns in patients with liver cirrhosis after gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid（Gd-EOB-DTPA） enhanced magnetic resonance imaging（MRI）. To explore the relationship between the level of liver and kidney enhancement and blood biochemical indicators. Methods Twenty-seven patients with cirrhosis CP（ChildPugh），including17 patients with grade A（CP A），10 patients with grade B or C（CP B/C）and 17 adults with normal liver and kidney function（control group）underwent plain scan and Gd EOB-DTPA enhanced MRI. At 5，10，15 and 20 minutes after bolus administration of Gd-EOB-DTPA，the signal intensity ratios of liver，portal vein and theerector muscle of spine at the same level ，and ratios of signal intensity of renal medulla and cortex to the erector muscle of spine at the same level were measured and calculated. The blood biochemical makers of all the participants were collected. The differences of ratios between the three groups at different time points were compared and the correlation between different indices were analyzed. Results There was significant difference in Sliver/SImuscle1 between the groups at each time point of hepatocyte-specific phase（P ＜ 0.05）. There was significant difference in SIportal vein/SImuscle1 between the groups at 15 and 20 minutes of hepatocyte-specific phase（P ＜ 0.05）and no significant differences between the groups at other time points（P ＞ 0.05）. Regarding the SImedulla/SImuscle2 ：significant differences were found between the control group and CP B/C group at 15 and 20 minutes（P ＜ 0.05）. There was significant difference between the CP A group and CP B/C group at 5，15 and 20 minutes. There was significant difference between control group and CP A group at 5 minutes. Concerning the SIcortex/SImuscle2 ：there were significant differences between the control group and CP B/C group and between the CP A group and CP B/C group at 10，15 and 20 minutes. There were significant differences between the control group and CP A group at 15 and 20 minutes. At 20 minutes，Sliver/SImuscle1 was highly positively correlated with Alb，and highly negatively correlated with AST （P ＜ 0.05）.Sliver /SImuscle1 was moderately negatively correlated with TBiL， Glb， γ-GT and PT （P ＜ 0.05）； SImedulla/SImuscle2 and SIcortex/SImuscle2 were moderately negatively correlated with Sliver /SImuscle1 and moderately positively correlated with Sportal vein/SImuscle1 （P ＜ 0.05）. SImedulla/SImuscle2 and SIcortex/SImuscle2 were not correlated with Cr and eGFR（P ＞ 0.05）. Conclusion Biliary tract excretion of Gd-EOB-DTPA is decreased in patients with liver cirrhosis with normal renal function，the renal excretion compensation is increased and the excretion time is prolonged in these patients. The degree of the renal excretion and time is related to the level of liver cirrhosis. The evaluation of liver cirrhosis by Gd-EOB-DTPA enhanced MRI has a good clinical relevance. The degree of renal enhancement can indirectly indicate the degree of liver function damage.

Objective To compare the effects of adjusting tube voltage and adaptive statistical iterative reconstruction （ASIR）-V percentage on dose reduction in contrast-enhanced infant abdominal CT. Methods Twenty infants who received contrast-enhanced abdominal CT with 80 kVp and 40% ASIR-V were retrospectively analyzed（common group）. Forty age-，sex-，and weight-matched infants were recruited prospectively and divided into two groups ：low tube voltage group scanned with 70 kVp and 40% ASIR-V and high ASIR-V percentage group scanned with 80 kVp and 60% ASIR-V. The CT dose index（CTDI），dose length product （DLP），size-specific dose estimate（SSDE）and effective dose（ED）of single phase were recorded and calculated. In addition，two radiologists evaluated the image quality score using five-point method subjectively. Interobserver agreements for image quality evaluating was assessed by intra-class correlation coefficient（ICC）. One-wayANOVA was used to compare the dose parameters among three groups．Bonferroni test was used for further pairwise comparison. Results Sex，age and weight showed no statistically significant difference among the three groups （P ＞ 0.05）. The CTDI were（0.51±0.06）mGy、（0.34±0.03）mGy、（0.31±0.04）mGy in common group，low tube voltage group and high ASIR-V percentage group，respectively. DLP were（8.94±1.40）mGy-cm、（5.85± 0.72）mGy-cm、（5.53±0.75）mGy-cm. SSED were（1.15±0.12）mGy、（0.76±0.06）mGy、（0.68±0.07）mGy. ED were（0.35±0.08）mSv、（0.26±0.05）mSv、（0.21±0.03）mSv. Image quality score were 4.26±0.30，3.74±0.28 and 3.50±0.53. All dose parameters and image quality score were statistically significantly different among the three groups（P ＜ 0.001）. Radiation dose and image quality score of low tube voltage group and high ASIR-V group were significantly decreased than these of common group（P ＜ 0.001），but image quality score met the diagnostic criteria in all groups（≥ 3）. Image quality score had no statistically significant difference between low tube voltage group and high ASIR-V group（P ＞ 0.05）. Conclusion In contrast-enhanced infant abdominal CT, on the basis of conventional 80 kVp, ASIR-V 40% , reducing tube voltage by 10 kVp and increasing ASIR-V percentage by 20% achieved similar radiation dose reduction and similar image quality .

Objective To investigate the diagnosis and treatment of celiac arterial stenosis / occlusion after liver transplantation. Methods Retrospective analysis of clinical data, diagnosis and treatment of 4 patients with celiac arteriall stenosis / occlusion after liver transplantation. Results In this group of 4 patients with celiac arterial stenosis / occlusion after liver transplantation, the clinical manifestations were non-specific. Routine ultrasonography after surgery showed that the hepatic artery resistance index（RI）was less than 0.5, and hepatic artery stenosis was suspected. Later, hepatic arterial CT angiography（CTA）was used to confirm the diagnosis（the first 3 patients were diagnosed with stenosis and the latter patient was diagnosed with complete occlusion）, and 3 of them underwent interventional stent placement, one patient underwent balloon dilation. The success rate was 100%. The blood flow was completely restored. No complications related to interventional surgery and celiac arterial stenosis / occlusion occurred. The first 2 patients were followed up for more than 12 months, and the last 2 patients were followed up for more than 6 months. Ultrasound showed no significant abnormal hepatic artery blood flow. Conclusion For patients with celiac artery stenosed / occluded after liver transplantation, there is usually no clinical manifestation. Color Doppler ultrasound has an early suggestion, CTA examination of the hepatic artery can determine the location and degree of stenosis. And once the diagnosis is clear, interventional therapy is safe and effective and should be used as the preferred treatment

Objective Kidney transplantation can improve anemia in uremia patients due to the secretion of erythropoietin by the transplanted kidney. The use of marginal donors leads to an increasing incidence of delayed graft function（DGF）after renal transplantation，but there is still no study on whether the DGF process has an impact on post-transplant hemoglobin of transplant recipients. Understanding the impact of the DGF process on hemoglobin（Hb） and the incidence of post-transplantation anemia is helpful for the development of medical protocols and prognosis assessment. Methods A single center study of 94 kidney transplants recipients were included, 47 deceased donors were assigned as pairs of kidneys to two different recipients, one with DGF（in the DGF group）and one without DGF （in the nDGF group）. Their perioperative and post-operative hemoglobin changes and incidence of anemia were analyzed. Results Patients in the DGF group had a greater perioperative decrease in hemoglobin（P ＜ 0.05）, which was significantly lower than the nDGF group at one month post-operation（P ＝ 0.035）. At 3, 6, and 12 months post-transplantation, there was no significant differences in hemoglobin levels between the two groups（P ＜ 0.05）, while there was a certain kind of correlation（PCCs ＝ 0.426, 0.504, 0.391）. There was no significant difference in the incidence of anemia 1 year post-transplantation between the two groups（P ＝ 0.959）. Conclusion With similar donor quality, DGF resulted in a significant decline of hemoglobin of the recipient at perioperative period, but had no significant effect on the long-term（3 ~ 12 month）hemoglobin level, and no significant effect on the incidence of anemia. Long-term hemoglobin of the two recipients from the same donor were associated with each other.

Objective To investigate the effect of natural antibodies（Nabs）on long-term survival and rejection after renal transplantation. Methods The clinical data of 44 renal transplant recipients with antibodymediated rejection were studied retrospectively. Nabs was detected by enzyme linked immunosorbent assay（ELISA） method. According to the production of Nabs，the recipients were divided into Nabs+ group（n = 10）and Nabs- group （n = 34）. The graft survival after transplantation was recorded，and the differences of renal function and pathology of each group during rejection were observed at the same time. Results The graft survival rate in Nabs+ group was significantly lower than that in Nabs- group（P ＝ 0.044）. Post-transplant Nabs was also associated with an increase in the average Banff score of histological signs of graft injury in renal biopsy specimens. Estimated glomerular filtration rate（eGFR）in Nabs+ group was lower than that in Nab- group，but there was no significant difference （P ＞ 0.05）. Conclusion Nabs is associated with renal allograft injury and renal failure，suggesting that Nabs may be involved in the mechanism of immune rejection.

Objective To investigate the immunosuppressive effect of capecitabine（CAP）at different doses in rats and to explore its potential as an immunosuppressant. Methods Eighteen male BN rats were randomly divided into the control group（CON group），CAP low-dose group（metronomic chemotherapy，MET group），and CAP high-dose group（most tolerance dose，MTD group）. Three groups were administered with 1.2ml saline， 45 mg / kg and 200 mg / kg CAP by gastric gavage，respectively，the administration was performed twice per day and lasted for 21 days. The rat body weight was measured and 3 ml of venous blood was collected before administration and on the 7th，14th，and 21th day of administration. The total number of lymphocytes，T lymphocytes，CD4+ and CD8+ T lymphocytes in peripheral blood were measured by flow cytometry，and the concentrations of IL-2 and IFN-γ were measured by enzyme linked immunosorbent assay（ELISA）. Statistical analysis was performed on the changes of body weight，total lymphocyte count，T lymphocyte count，CD4+ and CD8+ T lymphocyte count，the level of IL-2 ，IFN-γ and their correlations in the three groups. Results All the rats in the three groups survived and gained weight gradually after 21 days of feeding. The weight gain of the MET group and MTD group was lower than that of the CON group，and the weight changes of the MTD group and the CON group were statistically significant at the 21th day 〔（214.17 ± 20.6）g vs.（235 ± 5.48）g，P ＜ 0.05〕. The total lymphocyte count，T lymphocyte count，CD4+ and CD8+ T lymphocyte count of MET group and MTD group decreased gradually. Compared with the CON group，the total lymphocyte count，T lymphocyte count，CD4+ and CD8+ T lymphocyte count of the MET group and the MTD group were significantly decreased on the 21th days after administration（P ＜ 0.05）. There was no significant difference between the MET groups and MTD groups（P ＞ 0.05）. Compared with the CON group，the levels of serum IL-2 and IFN-γ in the MET group and MTD group gradually decreased on the 7 th，14 th，and 21 th days after administration （P ＜ 0.05）. The decrease of the total lymphocyte count，T lymphocyte count，CD4 + and CD8+ T lymphocyte count in MET group and MTD group were positively correlated with the decrease of serum IL-2 and IFN-γ concentrations （P ＜ 0.05）. Conclusion Capecitabine can reduce the lymphocyte count in peripheral blood and inhibit the secretion of IL-2 and IFN-γ in rats，thus exhibiting immunosuppressive effect. The T cell suppressive intensity is positively correlated with the drug dose. Capecitabine has potential application value as an anti-rejection drug after liver transplantation.